Feasibility and long-term evolution of TIPS in cirrhotic patients with portal thrombosis

Perarnau, Jean–Marc; Baju, Alice; d’Altéroche, Louis; Viguier, J.; Ayoub, Jean

doi:10.1097/meg.0b013e328338d995

Cited by 98 publications

(84 citation statements)

References 43 publications

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“…[66][67][68][69][70] TIPS insertion and recanalization is associated with disrupture of the thrombus and mechanical thrombectomy. However, TIPS in such cases is expected to be technically challenging with a higher failure rate and should be attempted only in experienced centers.…”

Section: Tips and Thrombolysismentioning

confidence: 99%

Portal Vein Thrombosis in Cirrhosis

Raja

Jacob

Asthana

2014

Journal of Clinical and Experimental Hepatology

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Portal vein thrombosis (PVT) is being increasingly recognized in patients with advanced cirrhosis and in those undergoing liver transplantation. Reduced flow in the portal vein is probably responsible for clotting in the spleno-porto-mesenteric venous system. There is also increasing evidence that hypercoagulability occurs in advanced liver disease and contributes to the risk of PVT. Ultrasound based studies have reported a prevalence of PVT in 10-25% of cirrhotic patients without hepatocellular carcinoma. Partial thrombosis of the portal vein is more common and may not have pathophysiological consequences. However, there is high risk of progression of partial PVT to complete PVT that may cause exacerbation of portal hypertension and progression of liver insufficiency. It is thus, essential to accurately diagnose and stage PVT in patients waiting for transplantation and consider anticoagulation therapy. Therapy with low molecular weight heparin and vitamin K antagonists has been shown to achieve complete and partial recanalization in 33-45% and 15-35% of cases respectively. There are however, no guidelines to help determine the dose and therapeutic efficacy of anticoagulation in patients with cirrhosis. Anticoagulation therapy related bleeding is the most feared complication but it appears that the risk of variceal bleeding is more likely to be dependent on portal pressure rather than solely related to coagulation status. TIPS has also been reported to restore patency of the portal vein. Patients with complete PVT currently do not form an absolute contraindication for liver transplantation. Thrombectomy or thromboendovenectomy is possible in more than 75% of patients followed by anatomical end-to-end portal anastomosis. When patency of the portal vein and/or superior mesenteric vein is not achieved, only non-anatomical techniques (reno-portal anastomosis or cavo-portal hemitransposition) can be performed. These techniques, which do not fully reverse portal hypertension, are associated with higher morbidity and mortality risks in the short term. ( J CLIN EXP HEPATOL 2013;4:320-331)

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Section: Tips and Thrombolysismentioning

confidence: 99%

Portal Vein Thrombosis in Cirrhosis

Raja

Jacob

Asthana

2014

Journal of Clinical and Experimental Hepatology

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“…However, several large case series have confirmed the feasibility, safety and efficacy of TIPS for the treatment of non-tumoral PVT in liver cirrhosis [29][30][31][32][33][34]. The rate of technical success is high (75-100%) [29][30][31][32][33][34]. Once TIPS is successfully inserted, 87-100% of PVT patients can achieve portal vein recanalization [29][30][31][32][33][34].…”

Section: Portal Hypertension (Ph) Can Be Classified In the Following mentioning

confidence: 98%

“…At that time a TIPS was considered to be technically challenging and surgical portal vein decompression resulted in a significant milder transfusion dependency. However, several large case series have confirmed the feasibility, safety and efficacy of TIPS for the treatment of non-tumoral PVT in liver cirrhosis [29][30][31][32][33][34]. The rate of technical success is high (75-100%) [29][30][31][32][33][34].…”

Section: Portal Hypertension (Ph) Can Be Classified In the Following mentioning

confidence: 99%

“…The rate of technical success is high (75-100%) [29][30][31][32][33][34]. Once TIPS is successfully inserted, 87-100% of PVT patients can achieve portal vein recanalization [29][30][31][32][33][34]. Therefore, today, a TIPS most be considered in medical refractory patients with PHT and CV with acute/chronic anemia.…”

Section: Portal Hypertension (Ph) Can Be Classified In the Following mentioning

confidence: 99%

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Right Sided Colonic Varices: 2 Cases and Review of the Literature

Geenen¹,

Ja²

2015

J Gastrointest Dig Syst

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“…Among these, endovascular and surgical decompression of the portal system are considered the most optimal methods. 12,13 It should be noted that, currently, interest in the traditional portosystemic shunt (PSSh) method has decreased slightly. On one hand, this decrease is caused by the widespread introduction of minimally invasive techniques, among which priority is given to endovascular interventions (TIPS) and endoscopic techniques (ligation and sclerotherapy), and on the other hand, by a influence on the demand of bypass surgery, which has exerted a vast introduction of radical treatment for LC.…”

Section: Introductionmentioning

confidence: 99%